Blood Res 2016; 51(4): 249-255  https://doi.org/10.5045/br.2016.51.4.249
Clinical characteristics and outcomes of varicella zoster virus infection in children with hematologic malignancies in the acyclovir era
Seul-Ki Kim1, Min Chae Kim1, Seung Beom Han1,2, Seong Koo Kim1,3, Jae Wook Lee1,3, Nack-Gyun Chung1,3, Bin Cho1,3, Dae Chul Jeong1,2, Jin Han Kang1,2, Hack-Ki Kim1,3
1Department of Pediatrics, 2The Vaccine Bio Research Institute, 3The Catholic Blood and Marrow Transplantation Center, College of Medicine, The Catholic University of Korea, Seoul, Korea
Correspondence to: Seong Koo Kim, M.D.
Department of Pediatrics, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul 06591, Korea
E-mail: ksk3497@catholic.ac.kr
Received: March 3, 2016; Revised: May 8, 2016; Accepted: August 29, 2016; Published online: December 31, 2016.
© The Korean Journal of Hematology. All rights reserved.

cc This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background
Although intravenous acyclovir therapy is recommended for varicella zoster virus (VZV) infection in immunocompromised children, the clinical characteristics and outcomes of VZV infection in the acyclovir era have rarely been reported.
Methods
The medical records of children diagnosed with varicella or herpes zoster virus, who had underlying hematologic malignancies, were retrospectively reviewed, and the clinical characteristics and outcomes of VZV infection were evaluated.
Results
Seventy-six episodes of VZV infection (herpes zoster in 57 and varicella in 19) were identified in 73 children. The median age of children with VZV infection was 11 years (range, 1‒17), and 35 (46.1%) episodes occurred in boys. Acute lymphoblastic leukemia was the most common underlying malignancy (57.9%), and 90.8% of the episodes occurred during complete remission of the underlying malignancy. Acyclovir was administered for a median of 10 days (range, 4‒97). Severe VZV infection occurred in 16 (21.1%) episodes. Although the finding was not statistically significant, a previous history of hematopoietic cell transplantation (HCT) appeared to be associated with the development of more severe episodes of herpes zoster (P=0.075).
Conclusion
Clinical characteristics of VZV infection in immunocompromised children were not significantly different from those without it, and clinical outcomes improved after the introduction of acyclovir therapy. However, risk factors for severe VZV infection require further investigation in a larger population and a prospective setting.
Keywords: Varicella zoster virus, Leukemia, Lymphoma, Child


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